Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients

Jardins per a la salut

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia. Assignatura: Botànica farmacèutica. Curs: 2014-2015. Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són el recull de les fitxes botàniques de 128 espècies presents en el Jardí Ferran Soldevila de l’Edifici Històric de la UB. Els treballs han estat realitzats manera individual per part dels estudiants dels grups M-3 i T-1 de l’assignatura Botànica Farmacèutica durant els mesos de febrer a maig del curs 2014-15 com a resultat final del Projecte d’Innovació Docent «Jardins per a la salut: aprenentatge servei a Botànica farmacèutica» (codi 2014PID-UB/054). Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pels professors de l’assignatura. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica. També s’ha pretès motivar els estudiants a través del retorn de part del seu esforç a la societat a través d’una experiència d’Aprenentatge-Servei, deixant disponible finalment el treball dels estudiants per a poder ser consultable a través d’una Web pública amb la possibilitat de poder-ho fer in-situ en el propi jardí mitjançant codis QR amb un smartphone

Soporte vital extracorpóreo con oxigenación con membrana extracorpórea en pediatria: análisis de casuística y resultados del Hospital Universitario Vall d’Hebron

La oxigenación con membrana extracorpórea (ECMO) es una técnica que sustituye transitoriamente la función cardiaca y/o pulmonar. Es útil para salvar vidas y su uso ha aumentado exponencialmente durante la última década. El elevado coste y complejidad obliga a un uso adecuado de la misma. HIPÓTESIS La identificación de factores predictivos de la supervivencia puede contribuir a mejorar la indicación de la técnica y optimizar los recursos disponibles. La caracterización de las complicaciones neurológicas permitiría una aproximación a la morbilidad asociada a la técnica así como la identificación de variables relacionadas con estas complicaciones. OBJETIVOS Objetivo primario: identificación de factores predictivos de supervivencia al alta hospitalaria. Objetivos secundarios: identificación de factores predictivos de supervivencia en distintos momentos tras el inicio del soporte con ECMO. Determinar la prevalencia de las complicaciones neurológicas estructurales e identificación de factores relacionados con su aparición. MÉTODOS Estudio observacional descriptivo de los pacientes pediátricos y neonatales que recibieron soporte con ECMO en el Hospital Vall d'Hebron en el periodo comprendido entre marzo de 2002 y diciembre de 2015. RESULTADOS Se han incluido 120 pacientes (50% varones). La mediana (rango intercuartílico) de peso fue 4,2kg (3,3 - 10,5 kg) y edad de 91,5 días (10,5 días - 25,4 meses). La duración del soporte con ECMO fue de 177,5 horas (109,8 - 373,8 horas) y la supervivencia al alta hospitalaria del 41,6%. El 49,2% de los pacientes presentó una cardiopatía congénita y el 12,5% (del total de pacientes) tenía una fisiología univentricular. El 32,5% de pacientes habían sufrido un paro cardiorrespiratorio previo y el 10,8% eran pacientes inmunocomprometidos. Las variables relacionadas con la supervivencia al alta hospitalaria fueron: diagnóstico de hernia diafragmática congénita (OR 0,08; IC95: 0,01 – 0,85; p=0,036), fisiología univentricular (OR 0,14; IC95 0,02 – 0,9; p=0,038), empleo de ECMO pre-trasplante torácico (OR 33,44; IC95 1,89 - 591,07; p=0,017) y duración del soporte con ECMO (OR: 0,9977; IC95: 0,9957 - 1; p=0,047). La prevalencia de complicaciones neurológicas fue elevada (65%), con un predominio de lesiones focales (isquémicas o hemorrágicas) (40%). Un 14,2% de pacientes presentaron lesiones isquémicas, otro 14,2% lesiones hemorrágicas y un 11,7% lesiones de ambos tipos. Las lesiones focales son mayoritariamente supratentoriales (81%), múltiples (59,5%) y bilaterales (54,8%), con un discreto predominio de lesiones en el hemisferio derecho (28,6%) respecto al izquierdo (16,7%) en el supuesto de lesiones unilaterales. Las lesiones difusas presentan una distribución supra e infratentorial (79,3%), siendo la microhemorragia petequial la lesión más prevalente (26,9%). En el 24,3% de los fallecidos se estableció una relación directa entre la complicación neurológica y el fallecimiento. El empleo de ECMO veno-venoso con cánula de doble luz se asociada a menos complicaciones neurológicas. La canulación periférica cervical se asoció con menos lesiones hemorrágicas y el empleo de ECMO veno-venoso con menos lesiones isquémicas, mientras que la canulación periférica femoral se relaciona con complicaciones neurológicas de evolución fatal. Los pacientes pediátricos tienen mayor riesgo de complicaciones hemorrágicas y de complicaciones de evolución fatal que los pacientes neonatales. La prolongación del soporte extracorpóreo aumenta el riesgo de encefalopatía hipóxico-isquémica. CONCLUSIONES El diagnóstico de hernia diafragmática congénita, la fisiología circulatoria univentricular y la duración del soporte extracorpóreo se asocian a una mayor mortalidad al alta hospitalaria, mientras que el empleo de ECMO previo al trasplante de órgano sólido se asocia a mayor supervivencia. Las complicaciones neurológicas son muy frecuentes. La edad, el tipo de canulación, el tipo de soporte y la duración del mismo tienen impacto sobre la incidencia de este tipo de complicaciones.Extracorporeal membrane oxygenation (ECMO) is a technique that can transiently substitute the function of both the heart and lungs. This modality of life support has proven useful in saving lives and its use has increased exponentially during the last decade. Due to its complexity and associated high cost, it is imperative to apply it to the patients that may benefit the most. HYPOTHESIS Identifying predictors of survival for patients who may need ECMO support might be useful to make a more precise indication of this technology and to optimize the available resources. The characterization of central nervous system complications may prove useful to make an estimation of the morbidity associated to the technique. The identification of variables associated to the occurrence of this type of complications may be helpful for the implementation of preventive strategies. OBJECTIVES Primary objective: to identify mortality predictors at hospital discharge. Secondary objectives: to identify mortality predictors at different time points after ECMO initiation. To establish the prevalence of structural neurological complications and to identify factors related to them. METHODS An observational descriptive study of all the paediatric and neonatal patients supported with extracorporeal membrane oxygenation at Hospital Vall d'Hebron between March 2002 and December 2015. RESULTS One-hundred and twenty patients were included in the study (50% males). Median (interquartile range) weight was 4.2 kg (3.3 – 10.5 kg) and age was 91.5 days (10.5 days – 25.4 months). The duration of support was 177.5 hours (109.5 – 373.8 hours) and survival to hospital discharge was 41.6%. Among the whole cohort, 49.2% of patients had congenital heart disease, and 12.5% had univentricular physiology. One third of patients had suffered a cardiac arrest prior to ECMO initiation. The proportion of immunocompromised patients was 10.8%. Variables related to hospital survival were: diagnosis of congenital diaphragmatic hernia (OR 0.08; 95%CI: 0.01 – 0.85; p=0.036), univentricular physiology (OR 0.14; 95%CI 0.02 – 0.9; p=0.038), use of ECMO support before thoracic organ transplantation (OR 33.44; 95%CI 1.89 – 591.07; p=0.017) and duration of ECMO support (OR: 0.9977; 95%CI: 0.9957 - 1; p=0.047). The rate of neurological complications was high (65%), with focal lesions (ischemic or haemorrhagic) being most prevalent (40%). There was the same proportion of ischemic and haemorrhagic lesions (14.2%), and 11.7% of patients suffered from a combination of both. Most of the focal lesions were supratentorial (81%), multiple (59.5%) and bilateral (54.8%), being more frequent on the right side (28.6%) than on the left side (16.7%) when they were one-sided lesions. Diffuse lesions were mostly both supra and infratentorial (79.3%), microhaemorrhagic pattern being the most prevalent (26.9%). A neurological complication was the direct cause of death in 24.3% of the deceased patients. Double-lumen veno-venous ECMO use was associated with less neurological complications. Cervical peripheral cannulation was associated with less haemorrhagic complications and veno-venous ECMO with less ischemic lesions, while femoral cannulation was associated with lethal neurological complications. Paediatric patients were more prone than neonatal patients to suffering haemorrhagic and fatal complications. Prolongation of extracorporeal support increases the risk of hypoxic-ischemic encephalopathy. CONCLUSIONS Diagnosis of congenital diaphragmatic hernia, univentricular physiology and duration of extracorporeal support are associated with higher hospital mortality, but the use of ECMO before thoracic organ transplantation leads to a better survival rate. Neurological complications are frequent. Age, cannulation type, support type and duration of extracorporeal support are risk factors for the incidence of central nervous system complications

Soporte vital extracorpóreo con oxigenación con membrana extracorpórea en pediatria: análisis de casuística y resultados del Hospital Universitario Vall d’Hebron

La oxigenación con membrana extracorpórea (ECMO) es una técnica que sustituye transitoriamente la función cardiaca y/o pulmonar. Es útil para salvar vidas y su uso ha aumentado exponencialmente durante la última década. El elevado coste y complejidad obliga a un uso adecuado de la misma. HIPÓTESIS La identificación de factores predictivos de la supervivencia puede contribuir a mejorar la indicación de la técnica y optimizar los recursos disponibles. La caracterización de las complicaciones neurológicas permitiría una aproximación a la morbilidad asociada a la técnica así como la identificación de variables relacionadas con estas complicaciones. OBJETIVOS Objetivo primario: identificación de factores predictivos de supervivencia al alta hospitalaria. Objetivos secundarios: identificación de factores predictivos de supervivencia en distintos momentos tras el inicio del soporte con ECMO. Determinar la prevalencia de las complicaciones neurológicas estructurales e identificación de factores relacionados con su aparición. MÉTODOS Estudio observacional descriptivo de los pacientes pediátricos y neonatales que recibieron soporte con ECMO en el Hospital Vall d'Hebron en el periodo comprendido entre marzo de 2002 y diciembre de 2015. RESULTADOS Se han incluido 120 pacientes (50% varones). La mediana (rango intercuartílico) de peso fue 4,2kg (3,3 - 10,5 kg) y edad de 91,5 días (10,5 días - 25,4 meses). La duración del soporte con ECMO fue de 177,5 horas (109,8 - 373,8 horas) y la supervivencia al alta hospitalaria del 41,6%. El 49,2% de los pacientes presentó una cardiopatía congénita y el 12,5% (del total de pacientes) tenía una fisiología univentricular. El 32,5% de pacientes habían sufrido un paro cardiorrespiratorio previo y el 10,8% eran pacientes inmunocomprometidos. Las variables relacionadas con la supervivencia al alta hospitalaria fueron: diagnóstico de hernia diafragmática congénita (OR 0,08; IC95: 0,01 – 0,85; p=0,036), fisiología univentricular (OR 0,14; IC95 0,02 – 0,9; p=0,038), empleo de ECMO pre-trasplante torácico (OR 33,44; IC95 1,89 - 591,07; p=0,017) y duración del soporte con ECMO (OR: 0,9977; IC95: 0,9957 - 1; p=0,047). La prevalencia de complicaciones neurológicas fue elevada (65%), con un predominio de lesiones focales (isquémicas o hemorrágicas) (40%). Un 14,2% de pacientes presentaron lesiones isquémicas, otro 14,2% lesiones hemorrágicas y un 11,7% lesiones de ambos tipos. Las lesiones focales son mayoritariamente supratentoriales (81%), múltiples (59,5%) y bilaterales (54,8%), con un discreto predominio de lesiones en el hemisferio derecho (28,6%) respecto al izquierdo (16,7%) en el supuesto de lesiones unilaterales. Las lesiones difusas presentan una distribución supra e infratentorial (79,3%), siendo la microhemorragia petequial la lesión más prevalente (26,9%). En el 24,3% de los fallecidos se estableció una relación directa entre la complicación neurológica y el fallecimiento. El empleo de ECMO veno-venoso con cánula de doble luz se asociada a menos complicaciones neurológicas. La canulación periférica cervical se asoció con menos lesiones hemorrágicas y el empleo de ECMO veno-venoso con menos lesiones isquémicas, mientras que la canulación periférica femoral se relaciona con complicaciones neurológicas de evolución fatal. Los pacientes pediátricos tienen mayor riesgo de complicaciones hemorrágicas y de complicaciones de evolución fatal que los pacientes neonatales. La prolongación del soporte extracorpóreo aumenta el riesgo de encefalopatía hipóxico-isquémica. CONCLUSIONES El diagnóstico de hernia diafragmática congénita, la fisiología circulatoria univentricular y la duración del soporte extracorpóreo se asocian a una mayor mortalidad al alta hospitalaria, mientras que el empleo de ECMO previo al trasplante de órgano sólido se asocia a mayor supervivencia. Las complicaciones neurológicas son muy frecuentes. La edad, el tipo de canulación, el tipo de soporte y la duración del mismo tienen impacto sobre la incidencia de este tipo de complicaciones.Extracorporeal membrane oxygenation (ECMO) is a technique that can transiently substitute the function of both the heart and lungs. This modality of life support has proven useful in saving lives and its use has increased exponentially during the last decade. Due to its complexity and associated high cost, it is imperative to apply it to the patients that may benefit the most. HYPOTHESIS Identifying predictors of survival for patients who may need ECMO support might be useful to make a more precise indication of this technology and to optimize the available resources. The characterization of central nervous system complications may prove useful to make an estimation of the morbidity associated to the technique. The identification of variables associated to the occurrence of this type of complications may be helpful for the implementation of preventive strategies. OBJECTIVES Primary objective: to identify mortality predictors at hospital discharge. Secondary objectives: to identify mortality predictors at different time points after ECMO initiation. To establish the prevalence of structural neurological complications and to identify factors related to them. METHODS An observational descriptive study of all the paediatric and neonatal patients supported with extracorporeal membrane oxygenation at Hospital Vall d'Hebron between March 2002 and December 2015. RESULTS One-hundred and twenty patients were included in the study (50% males). Median (interquartile range) weight was 4.2 kg (3.3 – 10.5 kg) and age was 91.5 days (10.5 days – 25.4 months). The duration of support was 177.5 hours (109.5 – 373.8 hours) and survival to hospital discharge was 41.6%. Among the whole cohort, 49.2% of patients had congenital heart disease, and 12.5% had univentricular physiology. One third of patients had suffered a cardiac arrest prior to ECMO initiation. The proportion of immunocompromised patients was 10.8%. Variables related to hospital survival were: diagnosis of congenital diaphragmatic hernia (OR 0.08; 95%CI: 0.01 – 0.85; p=0.036), univentricular physiology (OR 0.14; 95%CI 0.02 – 0.9; p=0.038), use of ECMO support before thoracic organ transplantation (OR 33.44; 95%CI 1.89 – 591.07; p=0.017) and duration of ECMO support (OR: 0.9977; 95%CI: 0.9957 - 1; p=0.047). The rate of neurological complications was high (65%), with focal lesions (ischemic or haemorrhagic) being most prevalent (40%). There was the same proportion of ischemic and haemorrhagic lesions (14.2%), and 11.7% of patients suffered from a combination of both. Most of the focal lesions were supratentorial (81%), multiple (59.5%) and bilateral (54.8%), being more frequent on the right side (28.6%) than on the left side (16.7%) when they were one-sided lesions. Diffuse lesions were mostly both supra and infratentorial (79.3%), microhaemorrhagic pattern being the most prevalent (26.9%). A neurological complication was the direct cause of death in 24.3% of the deceased patients. Double-lumen veno-venous ECMO use was associated with less neurological complications. Cervical peripheral cannulation was associated with less haemorrhagic complications and veno-venous ECMO with less ischemic lesions, while femoral cannulation was associated with lethal neurological complications. Paediatric patients were more prone than neonatal patients to suffering haemorrhagic and fatal complications. Prolongation of extracorporeal support increases the risk of hypoxic-ischemic encephalopathy. CONCLUSIONS Diagnosis of congenital diaphragmatic hernia, univentricular physiology and duration of extracorporeal support are associated with higher hospital mortality, but the use of ECMO before thoracic organ transplantation leads to a better survival rate. Neurological complications are frequent. Age, cannulation type, support type and duration of extracorporeal support are risk factors for the incidence of central nervous system complications

Soporte vital extracorpóreo con oxigenación con membrana extracorpórea en pediatria : análisis de casuística y resultados del Hospital Universitario Vall d'Hebron

Departament responsable de la tesi: Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva.La oxigenación con membrana extracorpórea (ECMO) es una técnica que sustituye transitoriamente la función cardiaca y/o pulmonar. Es útil para salvar vidas y su uso ha aumentado exponencialmente durante la última década. El elevado coste y complejidad obliga a un uso adecuado de la misma.HIPÓTESISLa identificación de factores predictivos de la supervivencia puede contribuir a mejorar la indicación de la técnica y optimizar los recursos disponibles. La caracterización de las complicaciones neurológicas permitiría una aproximación a la morbilidad asociada a la técnica así como la identificación de variables relacionadas con estas complicaciones.OBJETIVOSObjetivo primario: identificación de factores predictivos de supervivencia al alta hospitalaria.Objetivos secundarios: identificación de factores predictivos de supervivencia en distintos momentos tras el inicio del soporte con ECMO. Determinar la prevalencia de las complicaciones neurológicas estructurales e identificación de factores relacionados con su aparición.MÉTODOSEstudio observacional descriptivo de los pacientes pediátricos y neonatales que recibieron soporte con ECMO en el Hospital Vall d'Hebron en el periodo comprendido entre marzo de 2002 y diciembre de 2015. RESULTADOSSe han incluido 120 pacientes (50% varones). La mediana (rango intercuartílico) de peso fue 4,2kg (3,3 - 10,5 kg) y edad de 91,5 días (10,5 días - 25,4 meses). La duración del soporte con ECMO fue de 177,5 horas (109,8 - 373,8 horas) y la supervivencia al alta hospitalaria del 41,6%. El 49,2% de los pacientes presentó una cardiopatía congénita y el 12,5% (del total de pacientes) tenía una fisiología univentricular. El 32,5% de pacientes habían sufrido un paro cardiorrespiratorio previo y el 10,8% eran pacientes inmunocomprometidos. Las variables relacionadas con la supervivencia al alta hospitalaria fueron: diagnóstico de hernia diafragmática congénita (OR 0,08; IC95: 0,01 - 0,85; p=0,036), fisiología univentricular (OR 0,14; IC95 0,02 - 0,9; p=0,038), empleo de ECMO pre-trasplante torácico (OR 33,44; IC95 1,89 - 591,07; p=0,017) y duración del soporte con ECMO (OR: 0,9977; IC95: 0,9957 - 1; p=0,047). La prevalencia de complicaciones neurológicas fue elevada (65%), con un predominio de lesiones focales (isquémicas o hemorrágicas) (40%). Un 14,2% de pacientes presentaron lesiones isquémicas, otro 14,2% lesiones hemorrágicas y un 11,7% lesiones de ambos tipos. Las lesiones focales son mayoritariamente supratentoriales (81%), múltiples (59,5%) y bilaterales (54,8%), con un discreto predominio de lesiones en el hemisferio derecho (28,6%) respecto al izquierdo (16,7%) en el supuesto de lesiones unilaterales. Las lesiones difusas presentan una distribución supra e infratentorial (79,3%), siendo la microhemorragia petequial la lesión más prevalente (26,9%). En el 24,3% de los fallecidos se estableció una relación directa entre la complicación neurológica y el fallecimiento. El empleo de ECMO veno-venoso con cánula de doble luz se asociada a menos complicaciones neurológicas. La canulación periférica cervical se asoció con menos lesiones hemorrágicas y el empleo de ECMO veno-venoso con menos lesiones isquémicas, mientras que la canulación periférica femoral se relaciona con complicaciones neurológicas de evolución fatal. Los pacientes pediátricos tienen mayor riesgo de complicaciones hemorrágicas y de complicaciones de evolución fatal que los pacientes neonatales. La prolongación del soporte extracorpóreo aumenta el riesgo de encefalopatía hipóxico-isquémica. CONCLUSIONESEl diagnóstico de hernia diafragmática congénita, la fisiología circulatoria univentricular y la duración del soporte extracorpóreo se asocian a una mayor mortalidad al alta hospitalaria, mientras que el empleo de ECMO previo al trasplante de órgano sólido se asocia a mayor supervivencia. Las complicaciones neurológicas son muy frecuentes. La edad, el tipo de canulación, el tipo de soporte y la duración del mismo tienen impacto sobre la incidencia de este tipo de complicaciones.Extracorporeal membrane oxygenation (ECMO) is a technique that can transiently substitute the function of both the heart and lungs. This modality of life support has proven useful in saving lives and its use has increased exponentially during the last decade. Due to its complexity and associated high cost, it is imperative to apply it to the patients that may benefit the most. HYPOTHESIS Identifying predictors of survival for patients who may need ECMO support might be useful to make a more precise indication of this technology and to optimize the available resources. The characterization of central nervous system complications may prove useful to make an estimation of the morbidity associated to the technique. The identification of variables associated to the occurrence of this type of complications may be helpful for the implementation of preventive strategies. OBJECTIVES Primary objective: to identify mortality predictors at hospital discharge. Secondary objectives: to identify mortality predictors at different time points after ECMO initiation. To establish the prevalence of structural neurological complications and to identify factors related to them. METHODS An observational descriptive study of all the paediatric and neonatal patients supported with extracorporeal membrane oxygenation at Hospital Vall d'Hebron between March 2002 and December 2015. RESULTS One-hundred and twenty patients were included in the study (50% males). Median (interquartile range) weight was 4.2 kg (3.3 - 10.5 kg) and age was 91.5 days (10.5 days - 25.4 months). The duration of support was 177.5 hours (109.5 - 373.8 hours) and survival to hospital discharge was 41.6%. Among the whole cohort, 49.2% of patients had congenital heart disease, and 12.5% had univentricular physiology. One third of patients had suffered a cardiac arrest prior to ECMO initiation. The proportion of immunocompromised patients was 10.8%. Variables related to hospital survival were: diagnosis of congenital diaphragmatic hernia (OR 0.08; 95%CI: 0.01 - 0.85; p=0.036), univentricular physiology (OR 0.14; 95%CI 0.02 - 0.9; p=0.038), use of ECMO support before thoracic organ transplantation (OR 33.44; 95%CI 1.89 - 591.07; p=0.017) and duration of ECMO support (OR: 0.9977; 95%CI: 0.9957 - 1; p=0.047). The rate of neurological complications was high (65%), with focal lesions (ischemic or haemorrhagic) being most prevalent (40%). There was the same proportion of ischemic and haemorrhagic lesions (14.2%), and 11.7% of patients suffered from a combination of both. Most of the focal lesions were supratentorial (81%), multiple (59.5%) and bilateral (54.8%), being more frequent on the right side (28.6%) than on the left side (16.7%) when they were one-sided lesions. Diffuse lesions were mostly both supra and infratentorial (79.3%), microhaemorrhagic pattern being the most prevalent (26.9%). A neurological complication was the direct cause of death in 24.3% of the deceased patients. Double-lumen veno-venous ECMO use was associated with less neurological complications. Cervical peripheral cannulation was associated with less haemorrhagic complications and veno-venous ECMO with less ischemic lesions, while femoral cannulation was associated with lethal neurological complications. Paediatric patients were more prone than neonatal patients to suffering haemorrhagic and fatal complications. Prolongation of extracorporeal support increases the risk of hypoxic-ischemic encephalopathy. CONCLUSIONS Diagnosis of congenital diaphragmatic hernia, univentricular physiology and duration of extracorporeal support are associated with higher hospital mortality, but the use of ECMO before thoracic organ transplantation leads to a better survival rate. Neurological complications are frequent. Age, cannulation type, support type and duration of extracorporeal support are risk factors for the incidence of central nervous system complications

The burden of non-SARS-CoV2 viral lower respiratory tract infections in hospitalized children in Barcelona (Spain) : A long-term, clinical, epidemiologic and economic study

Viral lower respiratory tract infections (LRTI) are the leading cause of hospitalization in children. In Catalonia (Spain), information is scarce about the burden of viral LRTIs in paediatric hospitalizations. The aim of this study is to describe epidemiological, clinical, virological and economic features of paediatric hospitalizations due to viral LRTI. From October 2012 to December 2020, children aged <16 years admitted to a tertiary paediatric hospital in Catalonia (Spain) with confirmed viral LRTI were included in the study. Virus seasonality, prevalence, age and sex distribution, clinical characteristics, hospital costs and bed occupancy rates were determined. A total of 3,325 children were included (57.17% male, 9.44% with comorbidities) accounting for 4056 hospitalizations (32.47% ≤ 12 months): 53.87% with wheezing/asthma, 37.85% with bronchiolitis and 8.28% with pneumonia. The most common virus was respiratory syncytial virus (RSV) (52.59%). Influenza A was associated with pneumonia (odds ratio [OR] 7.75) and caused longer hospitalizations (7 ± 31.58 days), while RSV was associated with bronchiolitis (OR 6.62) and was the most frequent reason for admission to the paediatric intensive care unit (PICU) (11.23%) and for respiratory support (78.76%). Male sex, age ≤12 months, chronic conditions and bronchiolitis significantly increased the odds of PICU admission. From October to May, viral LRTIs accounted for 12.36% of overall hospital bed days. The total hospitalization cost during the study period was €16,603,415. Viral LRTIs are an important cause of morbidity, hospitalization and PICU admission in children. The clinical burden is associated with significant bed occupancy and health-care costs, especially during seasonal periods

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients